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Yang Q, Xie J, Cai Y, Wang N, Wang Y, Zhang L, Li Y, Yu J, Li Y, Wang H, Zhang K. Efficacy and Safety of Combination Antifungals as Empirical, Preemptive, and Targeted Therapies for Invasive Fungal Infections in Intensive-Care Units. Infect Drug Resist 2022; 15:5331-5344. [PMID: 36110125 PMCID: PMC9470118 DOI: 10.2147/idr.s381851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/29/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To determine whether combinations of antifungal drugs are effective and safe for patients in intensive-care units. Methods This study compared the efficacy and safety of caspofungin (CAS), voriconazole (VOR), amphotericin B liposome (L-AmB), CAS+VOR, and CAS+L-AmB as empirical, preemptive, and targeted therapies for invasive fungal infection (IFI). Results Comparing the CAS, VOR, and CAS+VOR groups revealed that there were no differences in response rates between all therapy types, IFI-associated death within 90 days was less common in the CAS+VOR group (1.8%) than the VOR group (14.3%), and there were more adverse events in the VOR group than in the CAS group (P < 0.05). For empirical or preemptive therapy, the CAS group had a better response rate (80.0%) than the CAS+VOR group (47.1%), and there were more adverse events in the VOR group than in the CAS group (P < 0.05). For targeted therapy, no differences were found for efficacy and safety. There were no differences among the CAS, L-AmB, and CAS+L-AmB groups in efficacy and safety. Conclusion Patients who received CAS monotherapy as an empirical or preemptive therapy could achieve good outcomes. Patients who received CAS+VOR or CAS+L-AmB achieved almost the same outcomes when compared with those who received CAS, VOR, and L-AmB monotherapy as targeted therapies, but those who received CAS+VOR had a lower IFI mortality rate than did those who received VOR monotherapy.
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Affiliation(s)
- Qianting Yang
- Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Jiao Xie
- Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yan Cai
- Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Na Wang
- Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yan Wang
- Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Li Zhang
- Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Youjia Li
- Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Jingjie Yu
- Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Ya Li
- Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Haitao Wang
- Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Kanghuai Zhang
- Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
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Rouzé A, Estella Á, Timsit JF. Is (1,3)-β-D-glucan useless to guide antifungal therapy in ICU? Intensive Care Med 2022; 48:930-932. [PMID: 35771251 DOI: 10.1007/s00134-022-06766-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Anahita Rouzé
- Univ. Lille, CNRS, Inserm, CHU Lille, UMR 8576-U1285-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Service de Médecine Intensive-Réanimation, 59000, Lille, France
| | - Ángel Estella
- Intensive Care Unit, University Hospital of Jerez, Medicine Department of University of Cadiz, Cádiz, Spain
| | - Jean-François Timsit
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris Cité University, Paris, France. .,UMR 1137, IAME, Université Paris Cité, Paris, France.
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Verma R, Pradhan D, Hasan Z, Singh H, Jain AK, Khan LA. A systematic review on distribution and antifungal resistance pattern of Candida species in the Indian population. Med Mycol 2021; 59:1145-1165. [PMID: 34625811 DOI: 10.1093/mmy/myab058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 12/16/2022] Open
Abstract
The emergence of antifungal drug resistance in Candida species has led to increased morbidity and mortality in immunocompromised patients. Understanding species distribution and antifungal drug resistance patterns is an essential step for novel drug development. A systematic review was performed addressing this challenge in India with keywords inclusive of 'Candida', 'Antifungal Drug Resistance', 'Candidemia', 'Candidiasis' and 'India'. A total of 106 studies (January 1978-March 2020) from 20 Indian states were included. Of over 11,429 isolates, Candida albicans was the major species accounting for 37.95% of total isolates followed by C. tropicalis (29.40%), C. glabrata (11.68%) and C. parapsilosis (8.36%). Rates of antifungal resistance were highest in non-albicans Candida (NAC) species - C. haemuloni (47.16%), C. krusei (28.99%), C. lipolytica (28.89%) and C. glabrata (20.69%). Approximately 10.34% isolates of C. albicans were observed to be drug-resistant. Candida species were frequently resistant to certain azoles (ketoconazole-22.2%, miconazole-22.1% and fluconazole-21.8%). In conclusion, the present systematic review illustrates the overall distribution and antifungal resistance pattern of Candida species among the Indian population that could be helpful in the future for the formation of treatment recommendations for the region but also elsewhere.
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Affiliation(s)
- Rashi Verma
- Department of Biosciences, Jamia Millia Islamia, New Delhi, India.,Biomedical Informatics Centre, ICMR-National Institute of Pathology, New Delhi, India
| | - Dibyabhaba Pradhan
- Indian Council of Medical Research - Computational Genomics Centre, All India Institute of Medical Research, New Delhi, India
| | - Ziaul Hasan
- Department of Biosciences, Jamia Millia Islamia, New Delhi, India
| | - Harpreet Singh
- Indian Council of Medical Research - Computational Genomics Centre, All India Institute of Medical Research, New Delhi, India
| | - Arun Kumar Jain
- Biomedical Informatics Centre, ICMR-National Institute of Pathology, New Delhi, India
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Nanofibers as drug-delivery systems for antimicrobial peptides. Drug Discov Today 2021; 26:2064-2074. [PMID: 33741497 DOI: 10.1016/j.drudis.2021.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/11/2020] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
Microbial infections are a major worldwide public health problem because a number of microorganisms can show drug resistance. Antimicrobial peptides (AMPs) are small biomolecules that present antimicrobial and immunomodulatory activities. Despite their great potential, there are still many barriers to the formulation of these molecules. In this context, nanotechnological approaches such as nanofibers are candidate drug-delivery systems for AMP formulations. These nanomaterials have a large contact surface and may carry several AMPs (single or multilayer), directing them to specific targets. Thus, this review describes the main advances related to the use of nanofibers as drug-delivery systems for AMPs. These strategies can contribute directly to the design of new multifunctional wound dressings, coatings for prostheses, and tissue engineering applications.
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Abstract
PURPOSE OF REVIEW The successful treatment of surgical fungal infections depends of a timely and adequate source control alongside with the use of prompt systemic antifungals. The main challenge of antifungal use in critically ill surgical patients is to find a balance between rational versus indiscriminate use in order to accomplish an antifungal stewardship program. RECENT FINDINGS Surgical fungal infections represent an important burden in the daily clinical activity in many ICUs. The efficacy of the available antifungal drugs has not been adequately assessed in randomized controlled trials with surgical fungal infections in ICU patients. Most clinical experience is limited to case reports or uncontrolled case series. Due to the lack of adequate scientific evidence to assess the role of the different antifungals in surgical ICU patients, it is usually suggested to follow the recommendations for invasive candidiasis and candidemia. SUMMARY Antifungal use in the surgical patients admitted to an ICU is a complex matter and there are several elements to consider like the presence of septic shock and multiorgan failure, local epidemiology and antifungal resistance, among others. The proper use of antifungals alongside early recognition and prompt source control, are critical factors for improved outcomes.
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The authors reply. Crit Care Med 2019; 46:e174-e175. [PMID: 29337810 DOI: 10.1097/ccm.0000000000002860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liao J, Pan B, Liao G, Zhao Q, Gao Y, Chai X, Zhuo X, Wu Q, Jiao B, Pan W, Guo Z. Synthesis and immunological studies of β-1,2-mannan-peptide conjugates as antifungal vaccines. Eur J Med Chem 2019; 173:250-260. [DOI: 10.1016/j.ejmech.2019.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/20/2019] [Accepted: 04/01/2019] [Indexed: 01/06/2023]
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Capoci IRG, Faria DR, Sakita KM, Rodrigues-Vendramini FAV, Bonfim-Mendonça PDS, Becker TCA, Kioshima ÉS, Svidzinski TIE, Maigret B. Repurposing approach identifies new treatment options for invasive fungal disease. Bioorg Chem 2018; 84:87-97. [PMID: 30496872 DOI: 10.1016/j.bioorg.2018.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/17/2018] [Accepted: 11/16/2018] [Indexed: 12/29/2022]
Abstract
Drug repositioning is the process of discovery, validation and marketing of previously approved drugs for new indications. Our aim was drug repositioning, using ligand-based and structure-based computational methods, of compounds that are similar to two hit compounds previously selected by our group that show promising antifungal activity. Through the ligand-based method, 100 compounds from each of three databases (MDDR, DrugBank and TargetMol) were selected by the Tanimoto coefficient, as similar to LMM5 or LMM11. These compounds were analyzed by the scaffold trees, and up to 10 compounds from each database were selected. The structure-based method (molecular docking) using thioredoxin reductase as the target drug was performed as a complementary approach, resulting in six compounds that were tested in an in vitro assay. All compounds, particularly raltegravir, showed antifungal activity against the genus Paracoccidioides. Raltegravir, an antiviral drug, showed promising antifungal activity against the experimental murine paracoccidioidomycosis, with significant reduction of the fungal burden and decreased alterations in the lung structure of mice treated with 1 mg/kg of raltegravir. In conclusion, the combination of two in silico methods for drug repositioning was able to select an antiviral drug with promising antifungal activity for treatment of paracoccidioidomycosis.
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Affiliation(s)
| | - Daniella Renata Faria
- Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Karina Mayumi Sakita
- Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | | | | | | | - Érika Seki Kioshima
- Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
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